Job Description

job summary:
Tatum by Randstad is working with a growing Healthcare client in seeking a Medical Economics Director. This role will work with operational departments to recommend cost initiatives that produce positive financial results and better member outcomes. Managed care experience is required. This role is almost entirely remote- candidate must sit in NC or be willing to relocate.

location: Morrisville, North Carolina
job type: Permanent
salary: $100,000 - 130,000 per year
work hours: 8 to 5
education: Bachelor\'s degree
experience: 6 Years

responsibilities:
Responsibilities & Duties

Oversee service spending and reimbursement analysis and improvements

• Oversee monitoring and analysis of service spending and reimbursement trends to identify opportunities for improving financial performance
• Work with the CFO and SVP of Financial Operations to prepare and present regular financial reports to senior leadership, including forecasting future financial performance
• Work with the SVP of Financial Operations to develop yearly service budget based on operational goals and strategic plan
• Drive Medical Cost Action Plans and other Cost Initiatives
• Monitor and forecast medical utilization patterns and flag outliers
• Lead statistical analyses to assess effectiveness of clinical programs and initiatives in collaboration with the Chief Medical Officer (CMO) or designees
• Coordinate with leadership to incorporate dashboards into business processes.

Collaborate with Departments and Stakeholders on service delivery analytics, performance and cost

• Develop and maintain relationships with key stakeholders
• Collaborate with other departments within the organization to ensure alignment of goals and objectives.
• Work with the Clinical and Network Operations to develop and implement strategies to improve the service delivery performance
• Liaise with Clinical and Network Operations regarding financial implications of utilization and contract structures
• Liaise with IT to assist in enhancement of data warehouse BI analytics to include components that will assist in the evaluation of performance
• Work with the Business Intelligence team to design, validate and deploy health economics dashboards to support cost reduction, quality of care improvement, patient/plan member satisfaction, and program tracking

Manage and Develop staff

• Work with Human Resources and the EVP-CFO to attract, maintain, and retain a highly qualified and well-trained workforce
• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
• Organize workflows and ensure staff understand their roles and responsibilities
• Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
• Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
• Set goals for performance and deadlines in line with organization goals and vision
• Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development

Lead Performance Committee

• Oversee the Organization Performance Management Committee structure

Promote Innovation and Process Improvement

• Stay current on healthcare industry trends and regulations, and provide expert advice and recommendations
• Stay current on best practices and developments in the field of medical economics, and incorporate these into the organization\'s processes and systems
• Encourage a culture of continuous improvement within the medical economics team, and lead by example in promoting a culture of innovation
• Evaluate and monitor initiatives

qualifications:
Education & Experience

Bachelor\'s degree in Economics, Health Information Technology, Finance or a related field, and seven (7) years\' experience in managed care performing broad range of health plan data analytics, including three (3) years managing a team. Experience must include presenting to executive leadership; analysis of medical claims, clinical assessments, and EMRs; knowledge of health plan financial and regulatory reporting standards.

Knowledge, Skills, & Abilities

• Advanced knowledge of Medicaid Managed Care
• Understanding of the interface between clinical practice and outcomes research
• Advanced understanding of medical service cost forecasting
• Strong Microsoft Office (Word, Excel, PowerPoint) skills
• Team working skills, persistence, high energy, initiative, and creativity - with a proven ability to manage significant initiatives across organizations and across geographies required
• Proactive, assertive, and creative, approach to problem-solving
• Hands-on approach, with high attention to detail and accuracy required
• Ability to execute multiple tasks and adhere to strict deadlines in a fast-paced, changing, environment required

Interested candidates are encouraged to apply and reach out directly to Gabe Esquivel at gabriel.esquivel@tatum-us.com

skills: Medicare/Medicaid

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate\'s education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).

For certain assignments, Covid-19 vaccination and/or testing may be required by Randstad\'s client or applicable federal mandate, subject to approved medical or religious accommodations. Carefully review the job posting for details on vaccine/testing requirements or ask your Randstad representative for more information.

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